title: Renal Insufficiency Following Radiocontrast Exposure Trial (REINFORCE): a randomized comparison of sodium bicarbonate versus sodium chloride hydration for the prevention of contrast-induced nephropathy.
abstract: BACKGROUND
  For the prevention of contrast-induced nephropathy (CIN) after coronary angiography, hydration by 0.9% sodium chloride solution and N-acetylcysteine is currently recommended. However, it is unclear whether volume supplementation with sodium bicarbonate is better than with sodium chloride when used in conjunction with nonionic, low-osmolar iopamidol. The aim of this study was to analyze and compare the effects of sodium bicarbonate and sodium chloride on renal function in 145 patients exposed to nonionic iso-osmolar contrast medium iodixanol in a randomized study.
  
  
  METHODS
  Renal Insufficiency Following Radiocontrast Exposure is a prospective, randomized, single-center, double-blinded trial of 145 patients (age 72.6+/-6.7 years) with elevated baseline serum creatinine levels (mean 132.6+/-29.3 micromol/l). Eligible patients were randomized to either a 154 mEq/l infusion of sodium bicarbonate (n=71, group I) or sodium chloride 0.9% solution (n=74, group II). The primary endpoint was serum creatinine elevation beyond 25% or 44 micromol/l on the first or second day following exposure to the contrast medium. Serum creatinine, serum cystatin C, plasma viscosity, urinary enzymes alanine aminopeptidase and N-acetyl-beta-D-glucosaminidase, and alpha1-microglobulin were measured at baseline and on days 1 and 2 after contrast medium administration.
  
  
  RESULTS
  An overall proportion of five CIN (3.4%) was observed with equal distribution among the groups (4.2% in sodium bicarbonate group vs. 2.7% in sodium chloride group; P=0.614). Parameters of renal function demonstrated no differences between the two hydration regimens on day 1 after angiography; even on day 2 most parameters were similar in groups I and II.
  
  
  CONCLUSIONS
  Renal Insufficiency Following Radiocontrast Exposure demonstrates a homogeneously low rate of CIN after exposure to nonionic, iso-osmolar iodixanol regardless of the use of either bicarbonate sodium or sodium chloride solution for volume supplementation. Low-toxicity contrast media and any hydration may offset potential antioxidant effects of sodium bicarbonate.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, University of Rostock, Germany.
authors.forename: Esther
authors.initials: E
authors.lastname: Adolph
authors.forename: Birgit
authors.initials: B
authors.lastname: Holdt-Lehmann
authors.forename: Tushar
authors.initials: T
authors.lastname: Chatterjee
authors.forename: Susanne
authors.initials: S
authors.lastname: Paschka
authors.forename: Andreas
authors.initials: A
authors.lastname: Prott
authors.forename: Henrik
authors.initials: H
authors.lastname: Schneider
authors.forename: Thomas
authors.initials: T
authors.lastname: Koerber
authors.forename: Hüseyin
authors.initials: H
authors.lastname: Ince
authors.forename: Michael
authors.initials: M
authors.lastname: Steiner
authors.forename: Peter
authors.initials: P
authors.lastname: Schuff-Werner
authors.forename: Christoph A
authors.initials: CA
authors.lastname: Nienaber
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects / Q000379:methods; D003327:Coronary Disease / Q000000981:diagnostic imaging; D004311:Double-Blind Method; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000139:chemically induced / Q000517:prevention & control*; D017693:Sodium Bicarbonate / Q000008:administration & dosage*; D012965:Sodium Chloride / Q000008:administration & dosage*; D016896:Treatment Outcome; D014283:Triiodobenzoic Acids / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D003287:Contrast Media; D014283:Triiodobenzoic Acids; D012965:Sodium Chloride; D017693:Sodium Bicarbonate; C044834:iodixanol